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Ilagan-Ying YC, Park EY, Lam R, Gupta S. Pancreatic Neuroendocrine Tumor Presenting with Chylous Ascites: Multidisciplinary Workup to Differentiate from Malignant Ascites. J Gen Intern Med 2022; 37:2082-2085. [PMID: 35260958 PMCID: PMC9198176 DOI: 10.1007/s11606-022-07463-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 02/07/2022] [Indexed: 10/25/2022]
Affiliation(s)
- Ysabel C Ilagan-Ying
- Section of General Internal Medicine, Yale School of Medicine, West Haven, CT, USA
| | | | - Robert Lam
- Section of General Internal Medicine, Yale School of Medicine, West Haven, CT, USA
| | - Shaili Gupta
- Section of General Internal Medicine, Yale School of Medicine, West Haven, CT, USA.
- Department of Medicine, Veterans Affairs (VA) Connecticut Healthcare System, West Haven, CT, USA.
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Ray M, Oberoi AS, Surya T, Saikia J. Management of Lymphatic Leaks After Retroperitoneal Lymph-Node Dissections in Gynecologic Cancers. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mukurdipi Ray
- Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, Delhi, India
| | - Ajit Singh Oberoi
- Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, Delhi, India
| | - Tshv Surya
- Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, Delhi, India
| | - Jyoutishman Saikia
- Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, Delhi, India
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Kara H. Chylous Ascites Developing after Open Thoracoabdominal Aortic Aneurysm Repair in a Patient with Marfan Syndrome. Braz J Cardiovasc Surg 2020; 35:584-588. [PMID: 31478365 PMCID: PMC7454609 DOI: 10.21470/1678-9741-2019-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chylous ascites is the pathologic accumulation of chylous fluid in the peritoneal cavity, caused by lymphomas, metastatic malignancies, and abdominal surgeries, rarely due to surgical trauma of the cisterna chyli or its major branches. A 24-year-old man with history of Marfan syndrome presented to our hospital with abdominal distention, abdominal pain, fluid in the incision region, and weakness. He had underwent an elective open aneurysm repair surgery nine days before for thoracoabdominal aortic aneurysm. Computed tomography revealed massive fluid collection in the abdominal cavity, which was drained surgically. He was diagnosed with chylous ascites and was discharged after conservative treatment.
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Affiliation(s)
- Hakan Kara
- Department of Cardiovascular Surgery, Giresun Ada Hospital, Giresun, Turkey
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Postoperative Lymphorrhagia- a Possible Complication Following Cephalic Duodenopancreatectomy. ACTA MEDICA MARISIENSIS 2019. [DOI: 10.2478/amma-2019-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Abstract
Surgery associated with lymphadenectomy may sometimes result in a lymphorrhagia, which usually resolves spontaneously within a few days, sometimes becoming a refractory complication to the treatment. In the case of large flows, particular attention should be paid to hydro-electrolytic and protein losses. We present the case of a patient with persistent lymphorrhagia after a cephalic duodenopancreatectomy for a pancreatic head tumor. From the 5th postoperative day, the patient had a milky-like secretion on the subhepatic drainage tube. The discharge rate was variable, between 500 and 1500 ml per day, requiring parenteral administration of amino acids, plasma and electrolyte solutions. The postoperative progression was slowly favorable, with the patient discharge on the 25th day following surgery. There are several treatment options for a lymphorrhagia following an extended lymphadenectomy, from intensive parenteral therapy to peritoneal-venous shunt or ligation of the lymphatic vessel responsible for the production of lymphorrhagia. In this case the conservative treatment had a favorable result.
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Kostov S, Yordanov A, Slavchev S, Strashilov S, Dzhenkov D. First Case of Chylous Ascites after Laparoscopic Myomectomy: A Case Report with a Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E624. [PMID: 31547593 PMCID: PMC6843166 DOI: 10.3390/medicina55100624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 12/12/2022]
Abstract
Introduction: Chylous ascites is a rare form of ascites characterized by milk-like peritoneal fluid, rich in triglycerides. Clinical signs and symptoms include abdominal distention, pain, nausea, and vomiting. In gynecology, the most common cause for its occurrence is lymph dissection leading to impairment of major lymphatic vessels. There are only a few reported cases of chylous ascites arising after operations for benign diseases. Case report: We report a case of a 46-year-old female patient, who underwent laparoscopy for a myomatous node with chylous ascites occurring on post-surgery Day 2. The ascites was conservatively managed. The exact cause of the chyloperitonitis could not be determined. Conclusion: Although extremely rarely, chylous ascites may also occur in operative interventions for benign diseases in gynecological surgery.
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Affiliation(s)
- Stoyan Kostov
- Department of Gynecology, Medical University Varna, 9000 Varna, Bulgaria.
| | - Angel Yordanov
- Department of Gynecologic Oncology, Medical University Pleven, 5800 Pleven, Bulgaria.
| | - Stanislav Slavchev
- Department of Gynecology, Medical University Varna, 9000 Varna, Bulgaria.
| | - Strahil Strashilov
- Department of Plastic Restorative, Reconstructive and Aesthetic Surgery, Medical University Pleven, 5800 Pleven, Bulgaria.
| | - Deyan Dzhenkov
- Department of General and Clinical pathology, Forensic Medicine and Deontology, Medical University Varna, 9002 Varna, Bulgaria.
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Parmar K, Khanna A, Singh SK, Manoharan V. Chylous ascites following robot-assisted radical prostatectomy and extended pelvic lymph node dissection: Discussion of the aetiology and management of an unusual occurrence. JOURNAL OF CLINICAL UROLOGY 2018. [DOI: 10.1177/2051415818788501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Kalpesh Parmar
- Department of Urology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashish Khanna
- Department of Urology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shrawan Kumar Singh
- Department of Urology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vignesh Manoharan
- Department of Urology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Idiopathic Chylous Ascites in Pregnancy: A Case Report. IRANIAN JOURNAL OF PUBLIC HEALTH 2018; 47:1034-1036. [PMID: 30182003 PMCID: PMC6119575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Idiopathic chylous ascites in pregnancy is extremely rare. Here, we report a 24-yr-old patient with idiopathic chylous ascites in pregnancy. The patient was hospitalized in Xiamen Maternity and Child Health Care Hospital, Xiamen China in 2014 due to G1P0 intrauterine pregnancy 39+2 week, LOA, and time of labor. The patient gave birth to a live baby boy (3.6 kg) by spontaneous vaginal delivery, with complete delivery of placenta. Three hours after delivery, the patient reported abdominal distension and pain, as well as asthma. Later, milky white liquid was drawn from left lower abdomen by puncture. Exploratory laparotomy was performed, and 800 ml milky white liquid was drawn from the abdominal cavity. Subsequently, drainage tube was placed in the abdominal cavity, and the abdomen was closed. After the surgery, the patient was given low-fat diet, supplemented with parenteral nutrition support and intravenous injection of antibiotics. Extubation was performed on day 3. On day 7 after surgery, the mother and baby left the hospital without any health problems. No abnormality was observed during six months of follow-ups. Idiopathic chylous ascites in pregnancy may be related to congenital lymphatic system dysplasia, and directly caused by chylous flow from ducts into abdominal cavity induced by progesterone during pregnancy or pressure from enlarged uterus during late pregnancy. After pregnancy, the disease is cured by the release of disease cause and the reduction of thoracic duct pressure.
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Bhardwaj R, Vaziri H, Gautam A, Ballesteros E, Karimeddini D, Wu GY. Chylous Ascites: A Review of Pathogenesis, Diagnosis and Treatment. J Clin Transl Hepatol 2018; 6:105-113. [PMID: 29577037 PMCID: PMC5863006 DOI: 10.14218/jcth.2017.00035] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 09/26/2017] [Accepted: 09/30/2017] [Indexed: 12/12/2022] Open
Abstract
Chylous ascites (CA) is a rare form of ascites that results from the leakage of lipid-rich lymph into the peritoneal cavity. This usually occurs due to trauma and rupture of the lymphatics or increased peritoneal lymphatic pressure secondary to obstruction. The underlying etiologies for CA have been classified as traumatic, congenital, infectious, neoplastic, postoperative, cirrhotic or cardiogenic. Since malignancy and cirrhosis account for about two-thirds of all the cases of CA in Western countries, in this article we have attempted to reclassify CA based on portal and non-portal etiologies. The diagnosis of CA is based on the distinct characteristic of the ascitic fluid which includes a milky appearance and a triglyceride level of >200 mg/dL. The management consists of identifying and treating the underlying disease process, dietary modification, and diuretics. Some studies have also supported the use of agents such as orlistat, somatostatin, octreotide and etilefrine. Paracentesis and surgical interventions in the form of transjugular intrahepatic portosystemic shunt (commonly known as TIPS), peritoneal shunt, angiography with embolization of a leaking vessel, and laparotomy remain as treatment options for cases refractory to medical management.
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Affiliation(s)
- Richa Bhardwaj
- Department of Medicine, Division of Gastroenterology-Hepatology, UCONN Health, Farmington, CT, USA
- *Correspondence to: Richa Bhardwaj, Department of Medicine, Division of Gastroenterology-Hepatology, UCONN Health, Farmington, CT 06030, USA. Tel/Fax: +1-860-679-4613, E-mail:
| | - Haleh Vaziri
- Department of Medicine, Division of Gastroenterology-Hepatology, UCONN Health, Farmington, CT, USA
| | - Arun Gautam
- Department of Medicine, Division of Gastroenterology-Hepatology, UCONN Health, Farmington, CT, USA
| | | | - David Karimeddini
- Department of Diagnostic Imaging and Therapeutics, UCONN Health, Farmington, CT, USA
| | - George Y. Wu
- Department of Medicine, Division of Gastroenterology-Hepatology, UCONN Health, Farmington, CT, USA
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Mabiala Babela J, Ollandzobo Ikobo L, Loumingou R, Nika E, Mouko A. Syndrome néphrotique compliqué d’ascite chyleuse chez une fillette de 2 ans et 8 mois. Arch Pediatr 2017; 24:24-27. [DOI: 10.1016/j.arcped.2016.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 08/30/2016] [Accepted: 10/21/2016] [Indexed: 10/20/2022]
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Galanopoulos G, Konstantopoulos T, Theodorou S, Tsoutsas I, Xanthopoulos D, Kaperonis E, Papavassiliou V. Chylous Ascites Following Open Abdominal Aortic Aneurysm Repair: An Unusual Complication. Methodist Debakey Cardiovasc J 2016; 12:119-21. [PMID: 27486496 PMCID: PMC4969020 DOI: 10.14797/mdcj-12-2-119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Chylous ascites is a rare complication after abdominal aortic aneurysm repair. Accumulation of chyle within the close space of the peritoneal cavity may cause severe discomfort to the patient, complicating the postoperative course. Prompt diagnosis is needed to adopt measures for reducing lymph leakage and contributing to lymphatic fistula closure. Fortunately, conservative treatment is successful in the majority of cases. In the rare cases that do not respond to conservative treatment, surgery becomes mandatory. Accurate preoperative localization of lymph leakage is a prerequisite for a successful outcome. Postoperative chyloperitoneum has a benign course and an excellent prognosis.
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Affiliation(s)
- Georgios Galanopoulos
- Sismanogleio-Amalia Fleming General Hospital of Athens, Athens, Greece; Medical School of Athens, Athens, Greece
| | | | - Stavros Theodorou
- Sismanogleio-Amalia Fleming General Hospital of Athens, Athens, Greece
| | - Ioannis Tsoutsas
- Sismanogleio-Amalia Fleming General Hospital of Athens, Athens, Greece
| | | | - Elias Kaperonis
- Sismanogleio-Amalia Fleming General Hospital of Athens, Athens, Greece
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Ohki S, Kurumisawa S, Misawa Y. Chylous Ascites after Abdominal Aortic Aneurysm Repair. Ann Vasc Dis 2015; 9:48-50. [PMID: 27087873 DOI: 10.3400/avd.cr.15-00098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 11/20/2015] [Indexed: 11/13/2022] Open
Abstract
A 73-year-old man was transferred for treatment of abdominal aortic aneurysm. He had no history of abdominal surgeries. Grafting between the infra-renal abdominal aorta and the bilateral common iliac arteries was performed. Proximal and distal cross clamps were applied for grafting. He developed chylous ascites on the 5th post-operative day, 2 days after initiation of oral intake. Fortunately, he responded to treatment with total parenteral hyper-alimentation for 10 days, followed by a low-fat diet. There was no recurrence of ascites.
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Affiliation(s)
- Shinichi Ohki
- Division of Cardiovascular Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Soki Kurumisawa
- Division of Cardiovascular Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yoshio Misawa
- Division of Cardiovascular Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
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Lahiri D, Agarwal R, Roy MK, Biswas A. Chylous ascites and lymphangiectasia in focal segmental glomerulosclerosis--a rare coexistence: a case report. J Med Case Rep 2015; 9:34. [PMID: 25880780 PMCID: PMC4333874 DOI: 10.1186/s13256-014-0507-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 12/28/2014] [Indexed: 12/02/2022] Open
Abstract
Introduction Nephrotic syndrome is considered a rare cause of chylous ascites. Intestinal lymphangiectasia in a background of chylous ascites and without any lymphatic obstruction has been reported in association with yellow nail syndrome, which is a rare clinical occurrence in itself. The existence of chylous ascites, duodenal and splenic lymphangiectasia (without any lymphatic obstruction) and nephrotic syndrome in the form of focal segmental glomerulosclerosis in the same patient makes this case the first of its kind to be reported in the literature. Case presentation Here we report the case of a 54-year-old Asian man who presented with recurrent episodes of anasarca for approximately 25 years. He was subsequently found to have chylous ascites, lymphangiectasia and persistent proteinuria. A renal biopsy revealed focal segmental glomerulosclerosis, not otherwise specified. A lymphangiogram, which was performed with the purpose of addressing the intestinal lymphangiectasia, failed to demonstrate any abnormality of lymphatic channels. He was put on oral steroids with consequent remission of his oedema and proteinuria. Conclusions This case highlights the fact that duodenal and splenic lymphangiectasia can exist in a scenario of chylous ascites without any obvious obstruction of lymphatic channels and in the absence of yellow nail syndrome. This case also signifies that chylous ascites may be a rare presenting feature of nephrotic syndrome and hence this aspect should be considered while in diagnostic dilemma regarding such a clinical presentation.
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Affiliation(s)
- Durjoy Lahiri
- Department of General Medicine, IPGMER and SSKM Hospital, Kolkata, 700020, India.
| | - Rakesh Agarwal
- Department of General Medicine, IPGMER and SSKM Hospital, Kolkata, 700020, India.
| | - Manoj Kumar Roy
- Department of General Medicine, IPGMER and SSKM Hospital, Kolkata, 700020, India.
| | - Amrita Biswas
- Department of General Medicine, IPGMER and SSKM Hospital, Kolkata, 700020, India.
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